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Weight analysis of mastectomy specimens and abdominal flaps used for breast reconstruction in Koreans

  • Yun, Jiyoung (Department of Plastic and Reconstructive Surgery, Inje University Busan Paik Hospital) ;
  • Jeong, Hyung Hwa (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, Jonghan (Seoul Plastic Surgery Clinic) ;
  • Kim, Eun Key (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Eom, Jin Sup (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Han, Hyun Ho (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2017.09.01
  • Accepted : 2018.04.25
  • Published : 2018.05.22

Abstract

Background Slim patients or those with large breasts may be ineligible for breast reconstruction with an abdominal flap, as the volume of the flap may be insufficient. This study aimed to establish that abdominal tissue-based breast reconstruction can be well suited for Korean patients, despite their thin body habitus. Methods A total of 252 patients who underwent postmastectomy breast reconstruction with an abdominal flap from October 2006 to May 2013 were retrospectively reviewed. The patients' age and body mass index were analyzed, and a correlation analysis was performed between the weight of the mastectomy specimen and that of the initial abdominal flap. Results The average weights of the mastectomy specimen and initial abdominal flap were 451.03 g and 644.95 g, respectively. The ratio of the weight of the mastectomy specimen to that of the initial flap was $0.71{\pm}0.23$. There was a strong positive linear relationship between the weight of the mastectomy specimen and that of the initial flap (Pearson correlation coefficient, 0.728). Thirty nulliparous patients had a final-to-initial flap weight ratio of $0.66{\pm}0.11$. The 25 patients who underwent a contralateral procedure had a ratio of $0.96{\pm}0.30$. The adjusted ratio of the final flap weight to the initial flap weight was $0.66{\pm}0.12$. Conclusions Breast weight had a strong positive relationship with abdominal flap weight in Koreans. Abdominal flaps provided sufficient soft tissue for breast reconstruction in most Korean patients, including nulliparous patients. However, when the mastectomy weight is estimated to be >700 g, a contralateral reduction procedure may be considered.

Keywords

References

  1. Noone RB. Thirty-five years of breast reconstruction: eleven lessons to share. Plast Reconstr Surg 2009;124:1820-7. https://doi.org/10.1097/PRS.0b013e3181bf821a
  2. Tzafetta K, Ahmed O, Bahia H, et al. Evaluation of the factors related to postmastectomy breast reconstruction. Plast Reconstr Surg 2001;107:1694-701. https://doi.org/10.1097/00006534-200106000-00009
  3. Lazarus D, Hudson DA. A simple method for determining the weight of the TRAM flap intraoperatively at the time of breast reconstruction. Plast Reconstr Surg 2001;107:818-22. https://doi.org/10.1097/00006534-200103000-00025
  4. Yano K, Hosokawa K, Nakai K, et al. Skin-sparing mastectomy and immediate reconstruction with a deep inferior epigastric perforator flap. Breast Cancer 2003;10:275-80. https://doi.org/10.1007/BF02966729
  5. Laporta R, Longo B, Sorotos M, et al. One-stage DIEP flap breast reconstruction: algorithm for immediate contralateral symmetrization. Microsurgery 2016;36:7-19. https://doi.org/10.1002/micr.22390
  6. Nahabedian MY. Breast reconstruction: a review and rationale for patient selection. Plast Reconstr Surg 2009;124:55-62. https://doi.org/10.1097/PRS.0b013e31818b8c23
  7. Woo KJ, Kim EJ, Lee KT, et al. A novel method to estimate the weight of the DIEP flap in breast reconstruction: DIEP-W, a simple calculation formula using paraumbilical flap thickness. J Reconstr Microsurg 2016;32:520-7. https://doi.org/10.1055/s-0036-1581078
  8. Jeong WS, Han W, Eom JS. Comparison of aesthetic outcomes between vertical and horizontal flap insets in breast reconstruction with the TRAM or DIEP flaps. Aesthetic Plast Surg 2017;41:19-25. https://doi.org/10.1007/s00266-016-0757-z
  9. Paik JM, Lee KT, Jeon BJ, et al. Donor site morbidity following DIEP flap for breast reconstruction in Asian patients: is it different? Microsurgery 2015;35:596-602. https://doi.org/10.1002/micr.22495
  10. Laporta R, Sorotos M, Longo B, et al. Breast reconstruction in elderly patients: risk factors, clinical outcomes, and aesthetic results. J Reconstr Microsurg 2017;33:257-67. https://doi.org/10.1055/s-0036-1597822
  11. Disa JJ, McCarthy CM, Mehrara BJ, et al. Postmastectomy reconstruction: an approach to patient selection. Plast Reconstr Surg 2009;124:43-52. https://doi.org/10.1097/PRS.0b013e31818b9005
  12. Nahabedian MY, Momen B, Galdino G, et al. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 2002; 110:466-75. https://doi.org/10.1097/00006534-200208000-00015
  13. Kim EK, Eom JS, Hwang CH, et al. Immediate transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction in underweight Asian patients. Breast Cancer 2014;21:693-7. https://doi.org/10.1007/s12282-013-0443-9
  14. Werdin F, Peek A, Martin NC, et al. Superior gluteal artery perforator flap in bilateral breast reconstruction. Ann Plast Surg 2010;64:17-21. https://doi.org/10.1097/SAP.0b013e31819bd713
  15. Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg 2004;114:69-73. https://doi.org/10.1097/01.PRS.0000127797.62020.D4
  16. Craggs B, Patel N, Rozen WM, et al. TUGs into VUGs and friendly BUGs: transforming the gracilis territory into the best secondary breast reconstructive option. Plast Reconstr Surg 2016;137:900e-901e. https://doi.org/10.1097/PRS.0000000000002091
  17. Hamdi M, Craggs B, Brussaard C, et al. Lumbar artery perforator flap: an anatomical study using multidetector computed tomographic scan and surgical pearls for breast reconstruction. Plast Reconstr Surg 2016;138:343-52. https://doi.org/10.1097/PRS.0000000000002347
  18. Yap YL, Lim J, Yap-Asedillo C, et al. The deep inferior epigastric perforator flap for breast reconstruction: is this the ideal flap for Asian women? Ann Acad Med Singapore 2010;39:680-6.
  19. Fischer JP, Sieber B, Nelson JA, et al. Comprehensive outcome and cost analysis of free tissue transfer for breast reconstruction: an experience with 1,303 flaps. Plast Reconstr Surg 2013;131:195-203. https://doi.org/10.1097/PRS.0b013e318277856f
  20. Yim JH, Yun J, Lee TJ, et al. Outcomes of take-back operations in breast reconstruction with free lower abdominal flaps. Arch Plast Surg 2015;42:741-5. https://doi.org/10.5999/aps.2015.42.6.741
  21. Eom JS, Kim DY, Kim EK, et al. The low DIEP flap: an enhancement to the abdominal donor site. Plast Reconstr Surg 2016;137:7e-13e. https://doi.org/10.1097/PRS.0000000000001867
  22. Cheng MH, Robles JA, Ulusal BG, et al. Reliability of zone IV in the deep inferior epigastric perforator flap: a single center's experience with 74 cases. Breast 2006;15:158-66. https://doi.org/10.1016/j.breast.2005.06.006
  23. Bailey SH, Saint-Cyr M, Wong C, et al. The single dominant medial row perforator DIEP flap in breast reconstruction: three-dimensional perforasome and clinical results. Plast Reconstr Surg 2010;126:739-51. https://doi.org/10.1097/PRS.0b013e3181e5f844
  24. Barabas AG, Shafighi M, Sassoon EM, et al. The bilateral DIEP flap: a method of bipedicled anastomosis to a single internal mammary artery and venae comitantes. J Plast Reconstr Aesthet Surg 2008;61:1249-51. https://doi.org/10.1016/j.bjps.2008.01.018
  25. Yang JH, Lee TJ. Correlation of breast tissue density and body mass index. J Korean Soc Plast Reconstr Surg 2010; 37:732-5.

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